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Volume 12, Number 2 |
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| Implementing thromboprophylaxis – the cost |
Peter Rose, Editor |
Compliance with recommendations for assessment of all hospital inpatients for thromboprophylaxis comes at an additional cost to the hospital service. Extended thromboprophylaxis (ET) with low molecular weight heparin (LMWH) for an additional three weeks for elective hip replacements, hip fractures and other related high-risk surgical patients, as recommended by the National Institute for Health and Clinical Excellence (NICE), needs to be carefully costed. |
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| Harmonisation of D-dimers to predict DVT |
Chris Gardiner MsC PhD FIBMS Chief Biomedical Scientist, University College Hospital, London |
The increased availability of non-invasive imaging techniques and the reduced tolerance for diagnostic uncertainty have resulted in the use of diagnostic imaging in a greater number of patients with suspected deep vein thrombosis (DVT). As a result, the proportion of patients with suspected DVT who have a thrombus confirmed by objective testing has fallen to 15–25%. This has cost and workload implications, so a non-invasive, inexpensive screening test is desirable. |
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| Thrombin generation: a global screening test of haemostasis? |
Roger J Luddington MPhil PhD Principal Clinical Scientist, Haematology Department, Addenbrooke’s Hospital, Cambridge |
The prothrombin time (PT) and activated partial thromboplastin time (APTT), which form the backbone of laboratory screening for procoagulant deficiency in haemostasis, have remained largely unchanged for the past 40 years. Recently, the use of these non-physiologically triggered assays has been questioned. They detect congenital procoagulant deficiencies but their ability to predict bleeding risk is more uncertain. There is also an increasing demand to assess patients for thrombotic risk. |
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| Update on point-of-care devices for international normalised ratio testing |
Ellen Murray PhD Research Fellow, Department of Primary Care, University of Birmingham; Ian Jennings PhD CSci FIBMS Scientific Programme Manager, UK National External Quality Assessment Scheme for Blood Coagulation, Sheffield |
Point-of-care (POC) tests are currently used by a large number of non-healthcare scientists, including GPs, nurses, pharmacists and phlebotomists, as well as by patients who self-monitor their medical condition. Technological advances and miniaturisation of analysers have led to a large expansion of potential POC tests. In 1999, POC testing represented a US$4.9 billion annual market worldwide, and it has been increasing by 12% per annum. |
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| The burden of venous thromboembolic disease in medical patients |
Victoria Drought BA MRCP Specialist Registrar; David Parr MA MD MRCP Consultant Respiratory Physician, University Hospitals Coventry and Warwickshire NHS Trust |
Venous thromboembolism (VTE) contracted in hospital causes between 25,000 and 32,000 deaths in the UK every year and is the leading cause of death in approximately 10% of deaths in hospital. This is over 25 times the mortality related to Methicillin-resistant Staphylococcus aureus (MRSA) and exceeds the mortality from breast cancer, HIV and traffic accidents combined. |
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